S118 Impact of Rurality and Age at Onset on Pancreatic Cancer Survival: A Population-Based Study

Introduction: Pancreatic cancer is the third leading cause of cancer-related mortality, with increasing incidence and mortality among individuals younger than 50 years. However, the combined impact of rural residence and age at diagnosis on survival outcomes remains unclear. This study aimed to evaluate whether rurality influences survival in early-onset (<50 years) and late-onset (>50 years) pancreatic cancer using a population-based dataset. Methods: We used the Surveillance, Epidemiology and End Results database to identify patients aged 20–79 years diagnosed with pancreatic cancer between 2000 and 2020, categorizing them as early-onset (20–49 years) or late-onset (50–79 years). Rural vs urban residence was determined using Surveillance, Epidemiology and End Results rural-urban continuum codes. Kaplan–Meier analysis was used to compare survival, and multivariable Cox proportional hazards models assessed the impact of rurality on survival, adjusting for potential confounders. An interaction term tested whether rurality and age at onset had a combined effect on survival. Results: Of 34,996 patients, 3,000 had early-onset pancreatic cancer and 31,996 had late-onset disease. Among early-onset patients, 88.2% resided in urban areas, compared to 84.9% of those with late-onset disease. Five-year survival was lower in rural than urban residents for both early-onset (26% vs 31.2%) and late-onset cases (9.8% vs 12.1%). In adjusted analyses, urban residents had a lower risk of death than rural residents (aHR 0.93; 95% CI 0.91–0.97; P < 0.001). Late-onset patients had a significantly higher mortality risk than early-onset patients (aHR 10.66; 95% CI 5.00–24.84; P < 0.001). The interaction between rurality and age at onset was not statistically significant (aHR 1.02; 95% CI 0.89–1.16; P = 0.775), suggesting independent effects. Conclusion: Rural residence is associated with poorer 5-year survival in pancreatic cancer, independent of age at diagnosis. These findings underscore the urgent need for equitable healthcare access and targeted interventions in rural populations.